CommuteSwap Registration Form

To register for the program for the 1st of the month, you must submit your application by the 15th day of the preceding month to allow time for your application to be processed.

Please Complete All Fields

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Name: *

Home Address: *

City: *

State: *

Zip: *

Daytime Phone: *

Work Email: *

Employer: *

Which parking lot are you currently parking at when you drive to work? *

What is your parking sticker or card number? *

Please indicate if you plan to "Try the T" or "Workout to Work": *

Try the T

Workout to Work

Try the T

Please answer the questions below if you plan to "Try the T"

What type of MBTA transit pass do you plan to purchase?

On average, how long is your one-way commute by car to the LMA? minutes

Workout to Work

Please answer the questions below if you plan to "Workout to Work"

I plan to:

Bike to work

Walk to work

Jog to work

Other

If 'Other', please specifiy:

Release of Liability

CommuteWorks’ CommuteSwap Program is designed to encourage the use of public transportation by employees to the Longwood Medical and Academic Area. As a participant in the program, you agree to provide any information requested regarding your commute and parking practices accurately and completely. To be a participant in this program, you must be a registered parker at your institution. You must first receive approval from CommuteWorks before participating in the program. You must also truthfully record the costs of parking at the transit stations or cost of transit pass and failure to do so will result in your termination from the program. By registering for this program you are declaring to Medical Academic Scientific Community Organization, Inc., (MASCO) and to your employer that you are complying with all of the requirements of the program, as set forth above. At any time, should it be determined that you have failed to provide accurate information, or that you have failed to meet the requirements of the program, you expressly agree to refund MASCO for all costs incurred. These costs include, but are not limited to, any incentive benefits paid to you, plus the costs of collection, if any. Please also be advised that your employer will be promptly notified of any non-compliance. As always, you should consult your tax advisor concerning the tax consequences of any incentive.

Your e-mail address will not be made public or used for commercial purposes; however you may be contacted directly by CommuteWorks or MASCO Area Planning about commuting and transportation-related information or to request feedback regarding commuting and transportation services.

The Commuter hereby releases and hold harmless Medical Academic Scientific Community Organization and its subsidiaries, members, directors, officers, representatives, agents and employees from all claims, losses, liabilities, damages, injuries (including the reasonable cost of defense) arising out of, or in connection with this Agreement and participation in the CommuteSwap Program.

Thank you for registering with CommuteWorks' CommuteSwap Program. By submitting this form, you state that you have read and agree to the statement above.